(O ana. evasion O reevawron (© rrvaunt vision Method{s) of ‘Administration © direc Asestment © dermal Observation (© Revo ot Resor (© leformant interven Fiona LinguiSystemns Functional Communication Profile - Revised” ec SPEECH & LANGUAGE EVALUATION NORMAL -MLD.-—=MODERATE—=«SEVERE PROFOUND Sensory 0 G a o a Motor a a a o Oo Behavior o a a o a Attentiveness t a o a Receptive Language a a o o Expressive Language a o a a a Pragmatic/Social a a a a o Speech o Q a a a Voice ia) oO Oo a o Oral a a a o Fluency o o o o O wa ‘AT Zeta pc aecopiied prt he ewok fo mths, Ar cot is fo Sout oi oddity nd doa foEN DRY / MOTOR O Hearing © Auditory Localization O Vision Oye Contact O Visual Tracking © Visually Inspects Objects O Grasp O SottHelp Skills (O Head & Trunk Positioning O Gross Motor © Accepts Being Physically Guided (© Motor Imitation (O Inappropriate Behavior 1 normal mi oss 1D moderate oss severe loss 1D profoundioss C1 uncertain 1D may hear yet not react notes: __ __ — 1D adequate D tar 1D inconsistent D poor Ol none 1D selective to certain source C1 tunetionat possible loss] mesial condition (1 indness 1 impaired (severity or typo} —_ ae 1 tenses proscribed __wom __not worn lenses not preserbed i adequate Omit detcts O tae O poor (1 bestwiobjects best wipersone 1 avoids 1 rone 1D na du to blindness 1D adequate 0 tar 1D Inconsistent 1 poor D best wiobjocts «1 best wipersone none Ona adequate 1D Inconsistent 1D poor 1D pone 0 adequate D tar CO momentary passive C1 eandomly esses 1 unable motor impaired, but possible 1 indopendent 1 needs assist Cl dependent Cl mixes ccommunicatton/swalowing implications: — —_ 1D amouiatoy 1 poor coordination (2 poorbalance C1 nan-ambulatory, 0 yes Ono 1 panialy resistive {acto defensive motor restrictions vaties with parson or situation C unprompted L wiphysical prompt [completely assisted rotused 1 nla—lacks vision 2 movement resticted (1 gross but not fie motor stereotype repeitive motor mannerisms stimulus fascinaon lights, smels,etc.) avoids physical contactor ignores 1 stimulus oversenstviy 1D proters objocts to parsons C1 poor sensory Integration 1H physical aggression C excessiveltual speech U verbal aggression 1 resticted intorestsfeccentre 1D mouthing inedible objectefbody parts 3 frequent ciothes changing 1D socal isolator’ withdraw 1D poor socal boundaries 1D theres to nonfunctional routes U poor safety awareness D proccoupation wilobject part 1D compuisve or rigid food stealing 1D tantrums 1 echotata 1D tejects change hoarding C1 selrabuse 1 solttak 1H tacks eal fear CI hyperactivity C1 property destruction Ll swoars/ousses _L) irational fears [7 easly agitated C1 Pica 1D threatens 1D noncompliant Done reported/absorved a other: — —_ — Copyright © 2009 Linge, is,© Attention Span, 1D adequate Cid cote O fair 1D poor 1D tatigues. 1D varies wimood object preoccupation) none O Distractibie I almost never. 1 cocasionally 1 moderately 1 frequentiy 1 constantly not observed Cl dapends on task or tne O Alertness 11 adequate Ci moderate Ow lothargie 1 nomtesponsive C1 solective © Response Rate 1 appropriate 1 impulsive Cl mild delays 1D) moderate delays) severe delays] no response C mixed (__ best recoptvly __ best exprossively) CO Awareness of Others) adequate Oi fair Gi poor 1 nomexistont seeks others I sregards others C1 maintains intraction O Awareness of Environmental Events 1 usually 1 moderately 7 ovoastonally D rarely 1 never U sensory impaired CI physical status restricts © Cooperation 1 adquate 1 wisome prompisC} whumerous prompis C) resis (O Native Language — O Languages Understood a oral Comprehension — C1 words O phrases sentences 1 none 1 simple D complex Ci directa indirect 7 only direct conversations ‘conversations requests requests I feral butnot a due to uses sign figurative hearing loss language O Understands Basic Concepts 1 tunetional CD titatione C1 poor 1 none (Check Concepts Understood: 1D eos i body parts C siz 1 shape 1D money 17 eject function C1 prepositions 1 categories CU samefditerent —C]-morefess 1 oppesttesisynonyms how many 1D emotions 1 physteal property Cl time 1D quantity Responds toName I on request O wisign wigesture 1 sensory oss 1D no response 17 wiphysical prompt may tune out others O Responds to Attention Commands] on roquest wisign C1 wigesture 1 rotuses ee unable 7 wiphysical prompt © Looks at Pictures UI wtorest C mildly atentve tacks interest = no 1 onlywhphotes «7 tems, not scenes nlaect Louie cod (© Accepts Objects: Presented 1 by request wigesture CO wiphyscal prompt C1 wtotal assistance D motoricaly unable 1 rejects On response 8 spontaneously © Gives Objects to Speaker D by request 1 wigesture C wiphysical promet C2 retuses 1D whotal assitance 1 no response Cl motorcaly unable (only if exchanging Routine Commands ——V=wherbalcomments T=wiotal assistance P= wiphysical prompt @-= wigesture S wligningInstuction M=winoter impairments = reused unable ‘Types of Commands: C. head up 1D wallow 1D pushiput 1 toue i shake itervimd C1 turn orvott U hands down, D smile 1 hod Ost 1D stana 1D come here 1 go 1 openietose mouth handshake CI elap (O Environmental ‘Commands 1D totowed on request 1D wirepeated command 1 wigectura! prompt 1D wiphyeteal prompt G mati-step commands (Dwinriten instruction total assistance requires 1 may understand buts motorcally restricted 1D wisign C1 needs situational cues wipicture cuos 1 follows routine 1D no response 1 reluses or uncooperative O Nonverbal Comprehension 1D gestures intonation changes O sarcasm 1 facial expressions ‘thers feoings & thoughts 1D social cues 1D body language U voice atlect of speakor context 1D hla due to sensory loss Object dentitication Ci verbal request C_wigesture C. wiphyscal prompt wisign 1 by function | whactie exploration Tl wlimited items C1 none O Two-Dimensional Recognition 1 photos tine drawings color drawings symbols i visual dotots I. safty signe 7 community logos C1 requires large pictures 1 unable 1D rales on context cuos [1 understands picture represents message or concept Mode of Presentation: 1 on verbal request C1 signod OI wten 1D pantomime U pointing prompt L) PECS C1 match object whicture match piture wipcture (© Languages Expressed —_ O Verbal status nonverbal verbal 1 non-oral 1D total communication ‘communicator communicator communicator ‘communicator ited verbal ited non-oral Jacks communication communicator ‘communicator O Expressive Level one unit single words 1D phrases 1 sontonces (Check highest level) 7) conversation Ona 4 ‘Coy © 2003 Lingssymter(O Methods of Communication O SoltExpression © Quality of ‘Selt-Expression © Object interaction O Appropriate Object Use © Operates Cause Effect tom O Descriptive Language Copyright ©2008 Lingus, ne Dooooa ooo vocalizations speach ‘peting 1D facial expressions gestures D actions ‘manipulates others) photo seubooklet word bookievboard C1) computerlaptop faatitated 1D augmentatve name o physical feeings ‘emotions o aspirations o fettious 0 pectic 1 variable: touches a Purposeful gaze operates for a cause & oft Most Common Prompting: independent a verbal o adequate o ‘winter imitations basi social exchanges experiences humor or joke Informed consent eds ‘maintains grasp a o ‘communication device a a a a a a 0 or purposeful gaze o random for ‘elt stimulation ulded assist resists prefers inappropriate tems ‘excessive preoccupation shares or shows others for symbole playfretend Lnprompted physically unable viphysical prompt repetitive in nature not observed rate naming Isolated action Integrated actions action soquonco narrates widlalogue defines central theme (ine “big picture’) 'D comments on thoughts or felings o fa ~ visually impaired signing 0 weting ‘yo gazolsignal C1 head nod pointing O word cards jctue booklevboard C) PECS ‘object manipulation C) object symbols ‘aciviy schedule C1 shows abject 1 one preferences 1 routines echolalla D interests concerns 1 cpinions share ious 1D newe events rrone expressed —C) unable vague Dust be infored tosses active reach ‘compulsive 1 also uses adaptive switon C) motor restrictions physical 71 gestural no response C1 unable \wiimited items oF during ADL Ingists on sameness Jacks interest or rejects only solitary unablanone worbal request \wlgestural prompt no interest limited tems only adaptive equipment targets insigniieant facts contains delayed echolalia Projects sal ito scene purely tora supplements verbal wigostures deduces conclusion risinteprets or distorts theme nonverbaleres Language, certs © Basie Communication Expression (Cheek all that apply) © Uses Common Gestures > Grammar Skills (O Vocabulary © Average Phrase Length Tre Expresses Cholose Expresses Pleasure Discomfort Expresses ‘Name Label Objects ‘items speach speaks imitates opeech sign language Tingorepels ‘iphabet sot writes ‘ypes picture eysteny PECs ‘word system ‘eye gaze ‘communioation| device Taciitaion pohntsigestures| facial expression takes object ody movements ‘hows ID tag orcard Tread nod answer nol expressed 1D spontaneous C1 adequate 1D excellent 1D none 1D extensive 1 basleftuneton Check All Types Used: 1 objects 1D presenttense acon 1D social forme D pronouns 1D action qualiy (adverbs) 1D similes, metaphors, puns 1 person D slang object quaty (adjocives) words Indicate Means: © spoken communication ovis 2 wa 1D stoned 11 wigosturl prompt C1 pastiense action C1 1 focaionédoction C1 wiptsical prompt O tain aC ted 1 places futurestense action 1D quantity yestno idiomatic expression (colloquia) Imitation Span 1D pietureleymbot D other: poor Ona C1 categories Cl possession 1 plurals 1 time concepts UI physical & femotonal states 1 swearing words printed message ‘Copyigt © 2003 Lingus Inear (© Communicative intent O Initiates Communication (O Answers Who, What, ‘& Where Questions O Answers When, Why, & How Questions nsw ‘Quest YesiNo O Asks Questions, (© Conversational Skills (© Communication Partners (© Conversational Topics © Tum-taking (Topic initiation Copii © 203 Linguiystems, ne a request tenvaction (I callsummon Cl complimentpraise 1 deny/nagate ask{or'more’ 1 seekisiect care (1 deserbe Nenvact (1 arm gain atention 1) seekatfection «express gratitude 1 instruct rotestresist —C) seck approval ©] make plans 1D deceive cgreettake leave CI Interupt others make frends) remind ‘command 0 socatze 7 aseort sett 1D ettiiee request assist CI ofr assievwan 1 offerempathy 1 porsuade Inform about set!) comment 11 sof advocate insult inform about others I agree I repair conversation (1 apologize provide information C) argue or dsagree C1) request clafcation C) contrat show interest in othorslactviy Carty meaninglexplain to play with others Cl suggosvadvico share intersts/obects wiathers Inquire 1 none demonstrated (I other: ‘appropriately 1 moderately Cl itaskediprompted C1 rarely ceasionally 1 excessively Cl only egocentric none consistently 1 inconsistently) minimally 17 notable consistonty Cl inconsistently minimatly 1 notable consstenty C1 inconsistently. minimatty 1 notable randomly (indiscriminate) 1 only concorning needs or desires simple forms 1 complex forms C1 uses changes in vocal inflection via gesture 1 none elctedlemitted C1 reported but not observed Interviews tstoner C) only conceming self C) unable appropriate C1 need improvement C1 limited 1 none ronver C1 vary wiitener 71 vary wimood family 71 poets or coworkers CI atalearagiver 1 Instructor community member Job coactvsuperisor (1 poor interest in relationships rene 1 other: — of mutual interest) selt-contered 1 appropriately about sof Inolevanttangential (} perseveratve —C] about uals one intiated = nla appropriate C1 needs cues 1 needs cues 17 needs cues ‘ceasionally ‘moderately frequently fale to attond «C1 dominates the C1 uninterested.) unable tolisteners conversation exchanging na Independent 1 wioccestonal C1 only w/assistance (1 none assistance or prompting a—nomeans 1 excessive for edd (circumscibedyunusual topiosPagmate Sec Langue cand Topic Maintenance adequate 1 prompted 1 minimal C1 unsucoosstul 1 raplay sits Tacks interesvmotvation Ona O Topic Elaboration ‘umber of diferent statements 1D indopendenty 1 intact verbal cues direct verbal prompts (1D wigraphic cues 1 onlyforfxaons not stinuable 1 nonverbal © Cause-Etfect Reasoning ( appropriate response or explanation 1D reutna/ote response or explanation fair response or explanation 1D only i prompted or dractod 7 not expressed O na (O Shares Personal Data © Appropriateness C consstont CD inconsistent CI oceasional andor ‘of Communication Descriptive Conditions (Chock al that apply.) A considers listener's perspective yes __ no uses soca les yes. _ no A knows where o say 1D knows what to say C1 impate topics 1D knows wher to say t rowerbal © Discusses News Events speci general 0 vague CO unawaraino treat 1 rote repetiisn wie meaning or levance unable to express O Readingtiteracy 0 tattors D namo numbers 1 key words C sunival words pases 1D paragraphs stor sions product abetstiogos) 1 none O Wrting/speting 1 bets 1D numbers 1 key words 1 name Ci phrases 1D conversation 1D ‘teottated 1D none (O Memory Short Term: 1 tunetionat C1 imtations C1 0 roca 71 not testable Long Term: 1D tunetiona i timitatonsiselecive C1 no recall C1 not testable C savantstke skits or calculations "EECH (© intenigioiity easily understood by thers 1D understood wiminor itiouty 1D understood wimodorate difeuty 1D understood wimajr iticlty not understandable 1D nonverbal or nla Proficiency Level: 2 words 1D phrases 1D conversation context mus Q Understood By Cl familar others 1 trained listeners] average Iisteners 2 al stenere 1 noone CD dlalct may intertore with intaligalty 8 Copyright © 003 Linguist,© Adjusts Speech to Improve Understanding (© Sounds Produced © Error Phonemes © Omitted Phonemes (© Dentition (O atticulators (Q ral-Motor imitation O Loudness Vocal Quality OPiten Copyright 208 Linguists In I successful i no change required C1 sometimes O raroly 7 unsuccessful I settenrects 1 requies constant cues 1D nonverbal 1 beginning (vowels, pb m,h,.n.ng) C0 intermediate sounds (yk gd) advanced intormediate (ch, sh, s, 1) 1 advanced (th, 2, z, wh) 1 consonant blends 1D nonspeech sounds 1 age appropriate CI delayed 1D goneralized distortions 1 unremarkable LD overbte C1 underte open bit Cl overcrowding ‘repaired cleft 1 minimal entiion —D wears braces 1 removable dentures C) absent C1 poor condition 1) uncooperative 1 some teeth are missing 1 adequate excessive O vaiabie U tnadoquata towimensty 1 moneloudness —) nonverbatnan-orat fades 17 Inappropriate oseting 1 reduced breath suppor 1D normal nasa 0 hoarse strained whining 1 stident 1D whispered 1 exposve U vocal try wet ysantvia 1 poptonia 1D vocal temors 7 spastic dysphonia_C)singsong 1D nomverbetnon-oat ( oulde-sae resonance appropriate 1 higherthan normal 1 foworrarge variable 0 monotone LL tmmature forage faeoto 1 nonverbal 1 plch breaks mimics oer’ pitch inapproptto sing nection changes for ral speech or echoiain inappropriate fr ganderoa (O Mouth Breather 0 a © Drooling a o a (Q Tongue Thrust c ‘Swallowing & Diet a a o always. 1 trachoostomy = absont a neatly always 1 medication prescribed atrost 7 gastrostomy tube) pureed texture ground toro chopped texture mechanical sot adaptive strategies: most ofthe ime] some ofthe ime not problem {ue to nasal congoston ‘on ooeaston 1 frequently I not obsorved sef-monitors 1 unmonitored 1 roqulres protective measures on swallow 1 during speech C1 not observed aspiration risk Cl adequate chewiswallow thickened liquids C1 coughing observed spillage C1 rapid eatingstting food pocketing uses adaptive equipment modified health et: Gro (O Fluency a (O Rate of Speech a Rhythm & Intonation 0 o a o Use of Sign Language 0 a © Meaning of Signs o O Level of Signs a O Sample Signs _ a a AC adequate 1 Protongations = inegular pauses 1 appropriate a variable a progressively faster] appropriate a robotic 1 prolongs vowels repetitions 1 blocks hating C1 nonverbal secondary mannerisms: ——_ too rapid 1 laboredslow ronwerbal C itters fo echolalla Inoreases for ritual speech low atecvintent (1 lacks afectintent nonverbal carlature patterns I singsong 1 qual stress chopoy C1 changes stress re: meaning _ yes _no ther (describe): CO [CNA verbal ‘ocommunicate wiphysical prompt) understands a simple a Independently oncommand = la o on command 1 emerging imitates rot stimulable not needed D wimotor iis expresses 1 none Ova complex 1 fingerspeling 1 nonfunctional emerging skills C1 wisigning prompt C1 wiPECS. 1D unsuecesstul 1D saquonce of cons wigestural prompts facitated wadaptve equipment ‘Copyright ©2003 Lingus, ne© Express Yesitio © Current systom 4 Effectiveness O Fine-Motor Abilities O Recommended Communication ‘System & Potential Tost Results 1D head nods 1D symbolrpoturee 1D accepts vs. rejects tenvactity 1D communication device 1 motor signals vocalization D notimitaons = fair ooog eye signal verbalizes signs 1D printed words spells wialphabet board rane or random poor C1 non-functional Current Communication Objectives Communication Strengths. Communication Weaknesses/Needs Copyright © 2003 Lingus "General Intervention Strategies Related Plans in Other Settings How Residential & Day Program Plans Coordinate How to integrate Communication with Other Disciplines (Psyoh., PT, O.T, Roc.) Recommendations, Progress, Referrals ‘& Medical Necessity ‘SPEECH ANGONGE PROLOG Tauren ‘conray co Printed in the U.S.A. 23-07-9 2 Copri © 203 Lingle, fe